Do the outcomes of orthopedic surgery performed with robotics outweigh the costs?

摘要

There are two areas in orthopedic surgery where robotics has been employed successfully: jointarthroplasty and pedicle screw instrumentation in spine surgery. In joint arthroplasty, robotics isused to aid the accuracy of bone cuts in total knee arthroplasty and the accurate placement of theacetabular component in total hip arthroplasty. Many cadaveric and retrospective clinical studieshave demonstrated high accuracy with bone cuts in arthroplasty leading to improved overall implantalignment and increased accuracy of screw placement in pedicle instrumentation. Despite theseadvantages, however, it is unclear whether robotic assistance results in improved outcomes thatjustify its added costs. For example, the advantages gained from robotics must outweigh the addedcosts of the robotic system itself, the annual service and maintenance fees of the system, as well as the cost ofdisposables. One also has to factor in the possible increased anesthesia and operative time in the beginning of thelearning curve for the surgeon, as well as the cost of preoperative advanced imaging or the use of intraoperativeCT/fluoroscopy to register the patient to be tracked by the navigational system. One area where robotic surgerymay improve cost-effectiveness is by decreasing the revision rates of joint arthroplasty and spine surgery. Somestudies suggest a decreased need for revision surgery with robotic assistance? however, these studies, at present,are generally retrospective studies with implicit bias. Robotics in orthopedic surgery is here to stay and will helpsurgeons in particularly complex cases? however, more evidence is needed to determine whether outcomes trulyoutweigh the costs in more routine surgical procedures.